Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis
Факторы, прогнозирующие послеоперационную заболеваемость после циторедуктивной хирургии по поводу рака яичников: систематический обзор и метаанализ
2022-01-01
SCID: 54.1/gatg74g6
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cytoreductive surgeryhypoalbuminemianeoadjuvant chemotherapyovarian cancerpostoperative morbidity
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Abstract (AI)
OBJECTIVE: Advances in ovarian cancer cytoreductive surgery have enabled more extensive procedures to achieve maximal cytoreduction but with a consequent increase in postoperative morbidity and mortality. The aim of this study was to evaluate factors for postoperative morbidity after extensive cytoreductive surgery for primary epithelial ovarian cancer (EOC), particularly those which may be modifiable. METHODS: Electronic databases were searched. Meta-analysis was conducted using random-effects models. RESULTS: Fifteen relevant studies, involving 15,325 ovarian cancer patients, were included in this review. Severe 30-day postoperative complications occurred in 2,357 (15.4%) patients. The postoperative mortality rate was 1.92%. Meta-analysis demonstrated that patient with following risk factors; age (p<0.001), Eastern Cooperative Oncology Group score >0 (p=0.001), albumin level <3.5 g/dL (p<0.001), presence of ascites on CT scan (p=0.013), stage IV disease (p<0.001) and extensive surgical procedure (p<0.001) has a significantly increase risk of developing postoperative complications. Surgical procedures including peritonectomy (p=0.012), splenectomy (p<0.001) and colon surgery (p<0.001) were significant predictors for postoperative complications. Moreover, we found that patients who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) had a lower risk of developing severe complications compared to those who underwent primary debulking surgery (PDS) (p<0.001). CONCLUSION: Our study demonstrated that patient performance status and hypoalbuminemia were the only significant adjustable preoperative risk factors associated with postoperative complications. Patients who underwent NACT-IDS had a lower risk of developing severe complications compared to PDS. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42021282770.
Key Findings
1
A systematic review of 15 studies involving 15,325 patients found severe 30-day postoperative complications in 15.4% and postoperative mortality of 1.92%.
2
Neoadjuvant chemotherapy followed by interval debulking surgery was associated with fewer severe complications than primary debulking surgery.
3
Older age, ECOG performance status above 0, hypoalbuminemia below 3.5 g/dL, ascites, stage IV disease, and extensive surgery significantly increased postoperative complication risk.
4
Performance status and hypoalbuminemia were the only significant adjustable preoperative risk factors identified for postoperative complications.
5
Peritonectomy, splenectomy, and colon surgery were significant surgical predictors of postoperative complications.
Research Object
Patients with primary epithelial ovarian cancer undergoing extensive cytoreductive surgery
Research Subject
Risk factors and treatment-related predictors of severe postoperative complications and mortality, including modifiable preoperative factors and the effects of NACT-IDS versus PDS
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2022-01-01
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